How to Talk with Schools About Your Child’s Struggle with Body Dysmorphic Disorder

For a child or teen with Body Dysmorphic Disorder (BDD), the symptoms can affect every part of his or her life, including school. Being consumed with obsessive thoughts about appearance can greatly interfere with focus and concentration, which are necessary to perform well in school. Students with BDD report major difficulties with keeping on track with material presented in classes. It is not that they want to be caught up in their BDD thoughts – they desperately try to resist the thoughts and pay attention, but often find themselves fighting a losing battle.

What makes BDD particularly problematic is that being in a classroom and around other students can often be a major trigger. Individuals with BDD feel as if others are thinking they are ugly. A BDD patient of mine once said to me that while she was in class, she kept thinking: “People probably are wondering why I even left the house looking the way I do. I feel like I am offending everyone around me with my ugly appearance.” Thoughts like these are common in people with BDD, and can often lead to school avoidance.

In addition, the compulsive behaviors associated with BDD can impair a student’s ability to get to school. Time-consuming rituals, such as putting on make-up, combing one’s hair in a certain way, or picking the “perfect” outfit, can take much more time than intended, leading students to be late for school or not show up at all. Even when students get to school, they report feeling exhausted by their BDD-related thoughts and rituals even before the school day starts. The intellectual, social, and physical energy required for getting through a day of school is often completely sapped by BDD symptoms. In addition to being problematic in the classroom, BDD can also affect one’s ability to get homework done, due to the rituals students do at home.

School can feel like a hostile environment for someone with BDD. It is common for middle and high school students to make comments and have conversations about appearance. However, those with BDD are profoundly more affected by these comments, the teasing that can take place, and even positive comments about appearance. For example, another individual with BDD explained to me, “When I get a compliment from someone that they like my new haircut, I begin obsessing about whether they were really telling me that my old hairstyle looked ugly. Or I start to wonder if they are even being genuine.”

As difficult as having BDD is, it can be made even worse by the lack of understanding by schools. BDD is often dismissed as vanity, which is inaccurate. Schools may think that students are just making an excuse to get out of class or homework – the most common reaction to a student with BDD by school personnel is “Everyone has issues about their appearance, especially in high school.” Sometimes people can come across as attacking the student with BDD’s character, thinking that they are “superficial,” “attention-seeking,” and “vain.” For people with BDD, it is the opposite. They are not trying to stand out as beauty queens or male models. They think they look so ugly, that their wish is to simply blend in and NOT stand out.

It is very important to have a comprehensive, information-sharing meeting with the school if BDD symptoms are interfering with a student’s academic functioning. Here are some practical ideas for working with school personnel:

  • Request a meeting with all relevant staff. For middle and high school students, parents can set up a meeting with the school’s principal, teachers, and school psychologist. For college and graduate students, one can set up a meeting with the student services/disability services department and have a mental health counselor or psychologist at that meeting. Ideally if someone is in treatment for BDD, the presence of their therapist (in person or via phone) can be invaluable in sharing information about the student’s condition and needs.
  • Describe the student’s experience and how BDD may be having an impact. As difficult as it may be for the student, it is important for school personnel to have some idea as to what they are going through. They do not need to know all the details, but it can be helpful if school personnel have enough information to understand why BDD may make certain school tasks (e.g. focusing in class, getting homework done, coming to school) more difficult.
  • Clarify expectations on both sides. Explain that it is important to validate the experience of someone with BDD, but also that it is not an excuse. You (as a parent or the student) know that there are academic expectations that need to be met. One of the purposes of the meeting is to get on the same page and remove any judgment, inaccurate assumptions, and/or misinformation about BDD and the student’s experience.
  • Discuss what options the student may have for putting supports in place while at school. This may require developing a 504 plan or Individualized Education Program (IEP) for middle and high school students. A 504 plan acknowledges that there is a disability present that interferes with academic functioning, and that reasonable accommodations can be made to enable a student to perform their academic tasks. An IEP is a more formal document that acknowledges that there is a disability interfering with a student’s ability to properly access the curriculum. Usually this requires that students receive some kind of different instruction than other students (e.g. having an aide to help them, going to a resource room during class time to be in a smaller classroom, etc.). For college and graduate students, it is different. There are no IEP’s, but sometimes accommodations can be made with individual professors.

One final note to add: It is not uncommon for students to refuse to go to school because they are too overwhelmed by BDD symptoms and cannot tolerate being seen by other people. Such individuals, with the help of a mental health professional, should be encouraged to go to school, but if their symptoms are too severe they may need in-home tutoring.

The ultimate goal is for everyone to be informed and to enable a student with BDD to meet their expectations academically. Remember that students with BDD are not looking to get out of school or doing homework. They feel at a loss as to how to manage the demands of school with a disorder like BDD that can get in the way of their ability to be successful.

by Roberto Olivardia, PhD